Storage.cloversites.com
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|Grocery/Food Stores |$ |Qty |Total |
|Copps/Pick n Save/ Roundys (4%) |25 | | |
| |50 | | |
| |100 | | |
|Festival Foods (3%) |25 | | |
| |50 | | |
| | 100 | | |
|Piggly Wiggly (3%) |25 | | |
| |50 | | |
|Walmart/Sam’s (2%) |25 | | |
| |100 | | |
|Woodman’s (5%) |50 | | |
| |100 | | |
|Gas |$ |Qty |Total |
|Citgo West Wi Ave 10% |25 | | |
|Grand Central Station Shell (10%) |50 | | |
| |100 | | |
|Kwik Trip (5%) |20 | | |
| |50 | | |
| |100 | | |
|Moto Mart (5%) |50 | | |
|Restaurants |$ |Qty |Total |
|Applebee’s (8%) |25 | | |
|Arbys (8%) |10 | | |
|Buffalo Wild Wings (8%) |25 | | |
|Burger King (4%) |10 | | |
|Chili’s (11%) |25 | | |
|Chipolte (10%) |10 | | |
|Chuck E. Cheese (8%) |10 | | |
|Cousin’s Subs (9%) |10 | | |
|Culver’s (10%) |5 | | |
| |10 | | |
|Dairy Queen (3%) |10 | | |
|Dunkin Donuts (3%) |10 | | |
|Fazoli’s (7%) |25 | | |
|Great Harvest Bread (6%) |10 | | |
|Hardee’s (5%) |10 | | |
|IHOP (8%) |25 | | |
|Little Caesar’s (8%) |20 | | |
|McDonald’s (5%) |10 | | |
|Noodles & Co. (8%) |10 | | |
|Olive Garden/Red Lobster (9%) |25 | | |
|Outback Steakhouse (8%) |25 | | |
|Panda Express (8%) |25 | | |
|Panera Bread (9%) |10 | | |
|Papa John’s (8%) |10 | | |
|Papa Murphy’s (8%) |10 | | |
|Pizza Hut (8%) |10 | | |
|Qdoba Mexican Grill (7%) |25 | | |
|Red Robin (9%) |25 | | |
|Starbucks (7%) |10 | | |
| |25 | | |
***SEE OTHER SIDE FOR COMMON PRE-ORDER CARDS***
OFFICE USE ONLY
Amount Received____________
Check # _____________
Cash ______________
Seller______________________
If Items have to be ordered:
Order Pick Up Site:
_____________________
Date order to be picked up:
____________________
I verify that I received the correct amount of scrip as specified on this purchase form.
Signature
_____________________
|Restaurants |$ |Qty |Total |
|Subway (6%) |10 | | |
| |50 | | |
|Taco Bell (5%) |10 | | |
|Texas Roadhouse (8%) |25 | | |
|TGI Fridays (9%) |25 | | |
|Uno (12%) |25 | | |
|Wendy’s (4%) |10 | | |
|Department Stores |$ |Qty |Total |
|JCPenney (5%) |25 | | |
|Kohl’s (4%) – can be used to pay |25 | | |
|Kohl’s credit card | | | |
| |100 | | |
|Macy’s (10%) |25 | | |
| | 100 | | |
|Sears (5%) |25 | | |
|Shopko (3%) – can be used optical |25 | | |
|and pharmacy | | | |
| |100 | | |
|Target (2%) |25 | | |
| |100 | | |
|Music/Movies |$ |Qty |Total |
|Family Video (12%) |10 | | |
|Marcus Theatres (9%) |25 | | |
|Home Improvement |$ |Qty |Total |
|Ace Hardware (4%) |25 | | |
|Fleet Farm (4.76%) |25 | | |
|Home Depot (4%) |25 | | |
|Lowes (4%) |25 | | |
| |100 | | |
|Menards (3%) |25 | | |
|Miscellaneous |$ |Qty |Total |
| (3%) |25 | | |
| |100 | | |
|American Eagle/Aerie (10%) |25 | | |
|Barnes & Noble (9%) |10 | | |
| |25 | | |
|Bath & Body Work(5%) |10 | | |
| |25 | | |
|Best Buy (3%) |25 | | |
| |100 | | |
|Cabelas (11%) |25 | | |
|CVS (6%) |25 | | |
|Dick’s Sporting Goods (8%) |25 | | |
| |100 | | |
|Gordmans (7%) |25 | | |
|iTunes (5%) |15 | | |
| | 25 | | |
|TJ Maxx/ HomeGoods (7%) |25 | | |
|Toys R Us/Babies R Us (3%) | 20 | | |
|Walgreens (6%) – can be used for |25 | | |
|prescriptions | | | |
Make Checks Payable to: SCRIP
*FREQUENTY IN STOCK * FREQUENTY IN STOCK * FREQUENTLY IN STOCK * FREQUENTLY IN STOCK
S TOCK
Scrip Purchase Form
Name________________________________________ Phone ________________ Date ____________
Debt Reduction
OFFICE USE ONLY
Amount Rec’d_________________ Seller _________ Check #______ Cash______
POSSIBLY IN-STOCK** PRE-ORDER CARDS PRE-ORDER CARDS PRE-ORDER CARDS
S TOCK
Updated: 9/30/16
/16
|Gas |$ |Qty |Total |
|BP/Amoco (1.5%) |50 | | |
|Marathon (3%) |25 | | |
|Shell (2.5%) |50 | | |
|Speedway/Super America (4%) |25 | | |
|Miscellaneous |$ |Qty |Total |
|American Girl (9%) |25 | | |
|Bed Bath & Beyond (7%) |25 | | |
|Build A Bear (8%)** |25 | | |
|Cabelas (11%) |100 | | |
|Catherine’/Lane Bryant/Fashion|25 | | |
|Bug (6%) | | | |
|Claire’s/Icing (9%)** |10 | | |
|Cold Stone (8%)** |10 | | |
|Disney (2%)** |25 | | |
| |100 | | |
| |1000 | | |
|Domino’s Pizza(8%)** |10 | | |
|Express (10%) |25 | | |
|Foot Locker (9%) |25 | | |
|Gamestop (3%) |25 | | |
|Great Clips (8%) |25 | | |
|Gymboree (13%) |25 | | |
|Hallmark (4%) |25 | | |
|Jo Ann Fabrics** (6%) |25 | | |
|Lands End (16%) |25 | | |
| |100 | | |
|Limited (9%) |25 | | |
|LL Bean (15%) |25 | | |
|Office Depot (4%)** |25 | | |
| |100 | | |
|Office Max (5%)** |25 | | |
|Old Navy / Gap(14%)** |25 | | |
|Payless Shoes**(13%) |20 | | |
|Pottery Barn/Williams Sonoma |25 | | |
|(8%) | | | |
|Sears (4%)** |25 | | |
|Talbots (13%) |25 | | |
|The Childrens Place (12%) |25 | | |
|Ulta Salon (4%) |25 | | |
Hundreds more retailers can be viewed online at
Let us know if you find a Retailer you want us to order for you!
Contact Geri Younger (Mon-Fri) at 734-8218 or
Dawn Denis at 205-6142
You may place orders online too.
Go to to set up an online account.
• Sign up for PrestoPay online to pay directly from your checking account rather than writing us a check.
• When you pay and place your order online your gift cards will be ready for pickup at Faith/Celebration, or
• Some retailers have eCards that can be paid for online and printed for immediate use – look for the ScripNow! Retailers such as Walmart, Kohls, Best Buy, Barnes & Noble, Home Depot, Applebee’s, Chili’s and many more.
THANK YOU!
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